ARTICLE - PUBLIC HEALTH PROGRESS ENCOURAGING

HAITI PUBLIC HEALTH PROGRESS 'ENCOURAGING'
(Medpage Today) - By Michael Smith

A year after the devastating Haiti earthquake, there has been "encouraging" progress in public health in the island nation, U.S. officials said.

One high spot has been the almost complete recovery of HIV/AIDS programs in the country, according to CDC director Thomas Frieden, MD, writing with colleagues in a Perspective article online in the New England Journal of Medicine.

Within four months of the Jan. 12, 2010 earthquake, the number of patients getting treatment at sites sponsored by the President's Emergency Plan for AIDS Relief (PEPFAR) stood at 94% of the pre-quake total, Frieden and colleagues reported.

Those sites formed the nucleus of an infrastructure that was later available for other health needs after the earthquake including the cholera outbreak later last year, according to U.S. AIDS Ambassador Eric Goosby.

"We were able to leverage this health infrastructure to marshal a rapid and robust response," Goosby told reporters in a telephone news conference on Monday to outline progress and challenges in public health in Haiti, which coincided with the publication of the CDC director's article.

The rubble of damaged buildings, the hordes of displaced people, and the cholera outbreak -- which has claimed an estimated 3,600 lives -- "may make it seem that little or no progress has been made," Frieden told reporters.

Although obstacles remain, he said, the country's public health infrastructure has made some steps forward.

An example, he and colleagues reported in the journal, is the Haitian national bacteriology lab in Port-au-Prince, one of the few public health structure in the capital to survive the shocks. Before the earthquake, Frieden and colleagues noted, it handled on average four samples a month.

Now, they reported, the lab -- equipped with rapid diagnostic tests and with its technicians retrained -- is handling 181 tests a month, on average, to confirm diagnoses of typhoid, diphtheria, and meningococcal meningitis, among other diseases.

"It's much more functional than it ever was," Frieden told reporters.

When cholera broke out, field response teams began investigating the earliest reports of severe watery diarrhea within a day, Frieden and colleagues wrote. The national laboratory identified the pathogen through rapid tests within hours, confirmed the identification through culture within two days, and characterized what drugs the organism was susceptible to, allowing treatment recommendations for clinicians.

Frieden agreed with Goosby that "PEPFAR has been enormously important."

In fact, he said, the HIV/AIDS centers have made substantial strides, despite the aftermath of the quake, in preventing mother-to-child transmission of HIV. In fiscal 2009, some 132,000 pregnant women were tested, compared with 156,000 in fiscal 2010.

The increased testing meant that 1,900 women were identified as being HIV-positive (up from 1,100 a year before) and treatment prevented transmission to their babies, he said.

Progress has not come cheaply, according to Carleene Dei, USAID's Haiti mission director. The U.S. spent more than $1 billion for the initial response to the quake, another $115 million for nutrition and health, and $40 million for the cholera outbreak. The CDC, she told reporters, has spent an additional $14.6 million.